Prostate cancer

Fortunately, the disease is not aggressive in its early stages and is curable in most cases. In the advanced stages, when it has spread to other organs, it can be slowed down considerably with new medications. The disease usually does not cause symptoms in its early stages, which makes prevention all the more important.

There are several known risk factors for prostate cancer that need to be considered when diagnosing it. These factors are:


• Heredity – Approximately 9% of prostate cancer patients have a hereditary form of the cancer.

• Age – prostate cancer is a rare disease in men under the age of 50. The risk of developing prostate cancer increases with age.

• Race – Prostate cancer is most common in black Americans, and it is rare in Asians.

• Food – consuming large amounts of animal fats increases the risk of developing prostate cancer.

Clinical symptoms or signs of the disease are largely determined by the anatomical position of the prostate. Its name, the suburethral or perineal, suggests that it is located just below the bladder and surrounds the initial part of the urethra. Prostate cancer develops slowly and does not cause any problems that the patient would feel for years. The disease is initially limited to the prostate only. As prostate cancer grows, it puts pressure on the urethra, narrowing it and causing difficulty urinating. Patients have a poor urine stream, strain when urinating and feel that their bladder is not emptying completely. Cancerous tissue can also grow into neighboring organs. It most often spreads towards the urinary bladder, where it can grow through the bladder neck and the entrance of the ureters into the urinary bladder. The result is a disturbed outflow of urine from the kidneys to the urinary bladder and impaired kidney function. Patients with prostate cancer often notice bloody urine. Prostate cancer can be the cause of blood in the seminal fluid. Skeletal pain occurs when prostate cancer spreads and overgrows bone tissue. Bone tissue overgrown with prostate cancer cells is more fragile. Even a minor injury can cause a bone to break, which is called a pathological fracture. Pathological fractures most often occur in the spine, which can result in paralysis of the lower body (paraplegia). When cancer cells also overgrow the bone marrow, patients are anemic (anemia).

Prostate cancer is a very common disease. The disease occurs more frequently with age. The success of treatment depends on early detection of the disease. Therefore, we advise men over the age of fifty (according to some guidelines, over the age of forty if the man has a first-degree relative with prostate cancer) to have an annual preventive prostate examination. The cause of prostate cancer is not clear. We have identified several risk factors that could influence the higher incidence of prostate cancer. These include hereditary factors (men with several men in their family who have had prostate cancer have a higher chance of developing the disease themselves), inflammation, sexual life, hormonal factors, a diet high in saturated fatty acids, race, etc.

The basic examination that you should have before your examination by a urologist is an abdominal ultrasound. During the preventive examination, the urologist will palpate your prostate through the anus (digital rectal examination - DRE). This assesses the size of the prostate and its consistency (soft, elastic, hard), as well as any isolated lumps that may be suspicious of a tumor. This gives us an impression of its size and relationship to the surrounding area. An uneven, poorly defined, lumpy prostate that cannot be accurately felt with a finger and is fixed to the surrounding tissues is characteristic of advanced prostate cancer. During the examination, you will donate blood for PSA, which all men have, but is a very good marker to help diagnose prostate cancer. An elevated PSA value does not necessarily mean prostate cancer. Elevated values ​​are also usually found in cases of prostate inflammation, large prostates, water retention, prostate massage and after cystoscopy. In case of suspicious findings for prostate cancer, we decide to perform mpMRI of the prostate or immediate transrectal ultrasound with prostate puncture (TRUZ). The removed tissue is examined by a pathologist, who provides a pathohistological diagnosis.

In the last year, fusion prostate biopsy (a combination of magnetic resonance imaging of the prostate and ultrasound) has also been available to patients in Slovenia, which is more accurate in finding minor suspicious changes in the prostate. If prostate cancer is diagnosed, you should consult a urologist. Together, you will discuss further measures and discuss the disease itself. Prostate cancer can be actively monitored, operated on (removing the entire prostate), irradiated, and in advanced cases, drug therapy is considered. The decision on therapy is influenced by many factors, such as PSA, stage of the disease, Gleason score, concomitant diseases, performance, age, personal expectations of the patient, and expected survival. Therefore, before diagnosis, we must carefully discuss with the patient and weigh the negative and positive consequences of the diagnosis. Screening programs have not yielded the desired results in improving the survival of patients with prostate cancer. We decide on earlier and more accurate diagnostics individually for younger men with a higher risk of developing the disease.

The Select MDx urine test has been available to urologists since the beginning of this year. During this time, we have gained quite a bit of experience and I must confirm that the use of the test is appropriate. With the Select MDx test, we can predict with 98 percent accuracy whether a patient has aggressive prostate cancer or not, without a biopsy. Based on the test results, we decide on further diagnostics. A prostate biopsy is still required for a definitive diagnosis of prostate cancer, but patients with a negative test can avoid a biopsy. In Slovenia, the Select MDx test is currently self-pay. The test is simple and painless. The urologist performs a prostate massage from the right and left sides. After the massage, the patient passes urine into a special container. The first stream is important. The sample is sent for analysis to the test manufacturer in the Netherlands. The analysis also takes into account data on the patient's age, possible abnormalities in the prostate, prostate volume, family history of prostate cancer, and PSA levels. The European Association of Urologists has already classified the Select MDX test as a form of prostate cancer diagnosis.

Finally, we would like to emphasize the importance of prevention. Regularly have check-ups with a urologist, measure your PSA, and have an abdominal ultrasound. Try to live a healthy life with plenty of exercise, a balanced diet, a less stressful life, and lose excess weight.

Author: asst. Simon Hawlina, MD, FEBU, urologist specialist